Aortic Stenosis

Overview

Aortic stenosis is a condition characterized by the narrowing of the valve between the lower left chamber of the heart and the aorta, the main artery that distributes blood to the body. Under normal circumstances, this valve opens fully when blood leaves the heart and closes tightly to prevent blood from leaking backward. However, when stenosis develops, the valve cannot open fully, and the heart may need to exert much more force to pump blood throughout the body.

This situation can set the stage for thickening of the heart muscle and exhaustion of the heart over time. Although the body can initially tolerate this strain, blood flow to vital organs may decrease as the narrowing progresses.

Aortic stenosis can stem from calcification related to aging or from congenital valve defects. The primary goal of treatment is to remove the mechanical obstruction in the valve to alleviate the excessive load on the heart and prevent serious complications such as heart failure or sudden rhythm disturbances.

Symptoms of aortic stenosis

As the narrowing in the heart valve increases, the heart's pumping power begins to become insufficient, and the body may signal this through the following.

Symptoms of aortic valve stenosis may include:

• Chest tightness or pain (Angina). Because the heart muscle works hard to push blood through a narrowed valve, it requires more oxygen; however, the blood flow to the heart vessels may be insufficient due to the narrowing. This can manifest as pressure, heaviness, or a burning sensation in the chest, especially during physical activity.
• Shortness of breath with exertion. The inability of blood returning to the heart from the lungs to move forward can lead to fluid accumulation in the lungs and a feeling of being out of breath. Initially seen only while climbing hills, this situation can make breathing difficult even at rest in later stages.
• Dizziness or fainting (Syncope). This occurs when the blood flow to the brain is momentarily insufficient due to the narrowing of the valve. Usually developing during rapid movement or climbing stairs, this can be considered a sign of significant blood flow restriction.
• Unusual fatigue and weakness. The inability of enough blood to enter the circulation to meet the basic needs of the body can cause the person to feel exhausted even during simple daily activities.
• Heart palpitations and irregular beats. The strain and enlargement of the heart muscle can disrupt the heart's electrical system. This can cause palpitations felt like a bird flapping its wings in the chest or rhythm irregularities.
• Heart murmur. This is the turbulent sound produced when blood passes through a narrow gap, heard by a doctor through a stethoscope during an examination. This sound provides the first clue about the severity of the narrowing.
• Swelling in the ankles and legs (Edema). As the right heart begins to be affected, the pooling of blood backward in the body can lead to fluid accumulation in the tissues and swelling.

Causes of aortic stenosis

Various factors that damage the structure of the aortic valve and restrict its mobility can lead to this condition.

Aortic valve stenosis causes include:

• Age-related calcification. Over the years, calcium can build up on the valves due to the stress and wear created by blood flow. These deposits can stiffen the valves, making them difficult to open. It is the most common cause seen in individuals over 65 years of age.
• Bicuspid aortic valve (Congenital defect). This occurs when the aortic valve, which normally has three leaflets, is born with two. This structural difference can cause the valve to wear out and calcify faster, potentially leading to the onset of stenosis at a younger age.
• Rheumatic fever. As a complication of childhood throat infections that are not fully treated, inflammation can occur in the heart valves. This inflammation can cause the leaflets to stick together and narrow over time.
• Past heart infections (Endocarditis). Damage caused by bacteria settling on the heart valves can set the stage for the development of stenosis or insufficiency by disrupting the valve structure during the healing process.
• Radiation therapy. Past radiation therapy received in the chest area (for certain types of cancer, for example) can cause the heart valves to stiffen and calcify years later.
• Kidney failure. Chronic kidney diseases can disrupt the calcium and phosphorus balance in the body, accelerating calcium accumulation on the heart valves.

Diagnosis of aortic stenosis

The diagnosis process aims to evaluate the structure of the heart and the blood flow velocity with millimetric precision:

• Echocardiogram (Echo). Imaging of the heart using sound waves. How much the valves open, blood flow velocity, and the thickness of the heart muscle can be clearly determined with this test; it is the gold standard of diagnosis.
• Electrocardiogram (ECG). Measures the electrical activity of the heart. It shows the thickening in the heart muscle (hypertrophy) and the rhythm disturbances that the narrowing may cause.
• Stress test. Observing how the patient's heart valve responds to the body's needs during exercise. It can be used to understand the severity of narrowing in patients without symptoms.
• Cardiac MRI. Provides a detailed image of the heart tissue, offering additional information about the valve structure and the degree of damage to the heart muscle.
• Cardiac catheterization (Angiography). Directly measuring the pressure difference at the valve by entering through a groin vein and checking the condition of the coronary vessels. It is performed in patients planned for surgery to see if there is any vascular blockage.

Treatment of aortic stenosis

Treatment is planned according to the severity of the narrowing and the patient's complaints. While medications may alleviate symptoms, the real solution is to mechanically repair or replace the valve.

• TAVI (Transcateter Aortic Valve Implantation). A modern method performed by entering through the groin vein without opening the chest cavity. A new valve is placed inside the narrowed one. It is a procedure with a very fast recovery process, preferred especially for older patients or those with high open-surgery risk.
• Surgical valve replacement (Open heart surgery). The narrowed valve is removed and replaced with a metallic or biological (made from animal tissue) valve. Long-term results are quite successful in young patients with low surgical risk.
• Balloon valvuloplasty. A procedure involving reaching the narrowed valve with a catheter and inflating a balloon to widen the valve. It is usually a temporary solution used in infants or high-risk patients who need to gain time until surgery.
• Medication therapy. Given to keep blood pressure under control, reduce the load on the heart, and regulate rhythm. However, medications cannot open the narrowed valve; they only help the heart cope with the narrowing.
• Regular follow-up and observation. Patients without symptoms and with mild narrowing are monitored with echocardiography at certain intervals (6 months or 1 year). Intervention is planned when the valve reaches a critical level.

Risks of aortic stenosis

Untreated or late-diagnosed aortic stenosis can lead to these serious complications.

Possible complications of aortic valve stenosis are:

• Heart failure. The constant strain on the heart to push blood through a narrow valve can eventually weaken the heart muscle, making it unable to pump enough blood to the body.
• Sudden cardiac death. Fatal rhythm disturbances can develop in patients with severe narrowing. This can cause the heart to stop suddenly, even when there are no symptoms.
• Stroke. Small pieces breaking off from calcified valves or clots forming on the valve can travel to the brain and block vessels.
• Infective endocarditis. Damaged and narrowed valves provide a suitable ground for bacteria to settle. This can lead to a serious infection within the heart.
• Pulmonary hypertension. As a result of the pressure increase in the heart reflecting on the lung vessels, lung blood pressure can rise, which chronicizes shortness of breath.

Prevention

While it is not always possible to completely prevent aortic stenosis, protecting heart health can slow down the process:

• Take throat infections seriously. To prevent rheumatic fever, severe sore throats in children and young people must be treated under a doctor's supervision.
• Prioritize dental hygiene. Bacteria in the mouth can reach the heart via the bloodstream and cause valve infections. Regular dental exams protect valve health.
• Control blood pressure and cholesterol. High blood pressure increases the stress on the aortic valve, and high cholesterol can accelerate calcification. Keeping these values within normal limits can extend valve life.
• Quit smoking. Smoking is one of the main factors that accelerate atherosclerosis and the calcification process in the valves.
• Regular health checkups. If there is a family history of heart valve disease, having regular heart exams even if there are no symptoms provides a chance for early diagnosis.

Preparing for your appointment

Being evaluated for aortic stenosis can be stressful, but preparation helps your doctor assess the severity of the condition and determine the best treatment plan. Symptoms may develop gradually, so detailed information is important.

What you can do:

• Record your symptoms: Chest pain, shortness of breath, fatigue, fainting, palpitations.
• Note when symptoms occur: During exercise or rest.
• Bring previous cardiac test results: Echocardiogram, ECG, stress test, angiography.
• Prepare a medication list.
• Summarize past medical history: Rheumatic fever, hypertension, prior heart disease.
• Mention family history of valve disease or sudden death.
• Monitor exercise tolerance.
• Bring wearable heart rhythm data if available.
• Note recent infections or fever.
• Review diet and lifestyle habits.
• Write down questions beforehand.
• Consider bringing a companion.

Questions you may want to ask your doctor:

• How severe is my aortic stenosis?
• Will I need valve replacement?
• Am I a candidate for TAVI or surgery?
• Can I exercise safely?
• Is medication enough for now?
• What symptoms should prompt urgent evaluation?
• How often should I have follow-ups?
• Is there a risk of endocarditis?
• How will this affect daily life?
• Are there pregnancy-related risks?

Your doctor may ask:

• When did symptoms start?
• Any fainting episodes?
• Changes in exercise tolerance?
• Prior heart disease diagnosis?
• Family history of valve disease?
• Smoking or alcohol habits?
• History of rheumatic fever?
• Difficulty with daily activities?